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Research reports a higher occurrence of eating disorders among transgender individuals. Transgender individuals report higher levels of body dissatisfaction, self-esteem, bullying, and social rejection, which are risk factors for developing eating disorders.
Eating disorders are complex mental illnesses whose recovery process commonly involves an interdisciplinary team of professionals. For individuals who also identify as transgender, there are added considerations for their recovery, such as whether to participate in gender-affirming treatment. Whether or not a transgender individual chooses to partake in gender-affirming medical interventions is a personal process dependent on personal recovery goals.
What is Gender-Affirming Hormone Therapy?
Gender-affirming hormone therapy is one of many gender-affirming medical interventions transgender individuals may seek out. Hormone therapy helps transgender individuals achieve physical changes to their appearance and body that better align with their gender identity.
When receiving hormone therapy, medications are prescribed to aid in the body’s increased absorption of either estrogen or testosterone, which are feminizing and masculinizing hormones. For transgender women and other trans-feminine people, gender-affirming hormone therapy involves increasing the effects of feminizing hormones through taking estrogen and blocking testosterone. For transgender men and other trans-masculine people, gender-affirming hormone therapy involves taking testosterone.
Hormone therapy must be continued for the duration of a person’s life to maintain the desired effects. Hormones can be taken in several forms including a pill, injection, patch, or cream. To receive hormone therapy, individuals may be required to participate in counseling for a certain period of time to receive a diagnosis of gender dysphoria, which is required by many insurance companies for coverage of the medications. The management of hormone therapy such as treatment dosages and monitoring for side effects can be conducted by a primary care physician.
Possible Effects of Feminizing Hormones
- Increase fat distribution around hips
- Decrease muscle bulk
- May reduce the size of the penis and testicles
- Tender breasts, which may increase slightly in size
- Body hair production may slow down
- Baldness could be slowed or stopped
Possible Effects of Masculinizing Hormones
- More beard and body hair growth
- Higher chance of developing baldness
- Higher libido
- Increased muscle bulk
- Deeper voice
- Stopped periods with possible breakthrough bleeding
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Benefits of Hormone Therapy
In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), gender dysphoria is characterized by incongruence between a person’s sex assigned at birth and their experienced/expressed gender.
The treatment for gender dysphoria targets the distress accompanying the incongruence between someone’s assigned sex and gender identity. Many times, treatment includes gender-affirming medical interventions to help lessen and/or alleviate the distress and, therefore, improve the individuals’ overall well-being.
A group of researchers conducted a systematic review of studies looking at the psychological outcomes of hormone therapy on transgender individuals. The review found that gender-affirming hormone therapy is associated with psychological benefits. These benefits include lower depression and anxiety and overall improved quality of life.
The psychological benefits of gender-affirming hormone therapy may have the ability to lessen an individual’s distress and increase overall functioning to the point that they no longer meet diagnostic criteria for gender dysphoria.
Eating Disorders Among Transgender Individuals
Research has found that transgender individuals are at a higher risk for developing eating disorders. This may be because transgender individuals report higher levels of body dissatisfaction. Body dissatisfaction may lead to attempts at manipulating the body’s appearance through eating habits.
The motivation behind eating disorder behaviors may differ for transgender individuals from the fear of weight gain commonly associated with cisgender individuals. Transgender individuals may use eating disorder behaviors to change their body’s appearance to better align with their experienced gender. They may exercise excessively to build muscle to appear more masculine, for example, restrict their food intake to decrease breast size, or lose weight to stop their period.
Also, transgender individuals are at a higher risk of experiencing bullying, societal rejection, and/or violence associated with their gender identity. These experiences tend to negatively impact self-esteem and lead to higher reports of anxiety and depression. Low self-esteem and mood disorders are other risk factors for individuals developing eating disorders.
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Hormone Therapy and Eating Disorders
Research has begun exploring whether gender-affirming medical interventions, such as hormone therapy, reduce the prevalence of eating disorder symptoms among the transgender population. Though research has shown that gender-affirming medical interventions do not directly reduce eating disorder symptoms, it does show that undergoing hormone therapy improves body satisfaction and higher body satisfaction is associated with lower eating disorder symptoms.
Research shows that transgender individuals who haven’t received hormone therapy report higher levels of anxiety, depression, and a lower quality of life. However, after receiving gender-affirming treatment, the levels of anxiety and depression reportedly decrease, and quality-of-life increases.
All in all, the research shows that individuals who are both transgender and suffering from eating disorders may want to consider hormone therapy as a part of their recovery so as to reduce mental distress and improve their quality of life.
Unique Considerations for Individuals with Eating Disorders
Eating disorder recovery is a challenging process involving both the mind and the body. Individuals must begin to build a more balanced relationship with food, which in turn may cause the body to change. Having the body change during recovery can be a challenging process to sit through.
Hormone therapy is a medical intervention for transgender individuals which physically alters the body’s appearance. Research has shown that these physical changes tend to result in greater body satisfaction for most transgender individuals. However, the physical changes may also bring up emotions related to eating disorder symptomology. Therefore, the physical changes associated with gender-affirming hormone therapy and their interaction with someone’s eating disorder recovery should be a consideration before undergoing hormone therapy.
Though there is research that can help educate individuals on these topics, at the end of the day, seeking gender-affirming treatment comes with many personal considerations.
If you are an individual who identifies as transgender who is considering gender-affirming hormone therapy and who is also in eating disorder recovery, consider having a conversation with a mental health professional about the potential benefits and challenges associated with gender-affirming hormone therapy. To find a provider near you, visit the Psychology Today Therapy Directory.